Vestibular Epilepsy Presenting With Isolated Recurrent Vertigo and Postictal Headache: A Case Report

Vestibular epilepsy, also referred to as epileptic vertigo syndrome, is a rare and underrecognized cause of recurrent episodic vertigo.Currently, there are no universally accepted diagnostic criteria for vestibular epilepsy.A 38-year-old woman presented with an eight-month history of recurrent spontaneous episodes of rotational vertigo lasting one to two minutes and occurring multiple times daily.Episodes were accompanied by nausea and vomiting and were followed by bilateral throbbing headaches.Neurological examination, bedside vestibular assessment, and cognitive screening were unremarkable.Brain magnetic resonance imaging demonstrated no structural epileptogenic lesion, while brainstem evoked response audiometry was normal.Electroencephalography revealed frequent generalized epileptiform discharges with a photoparoxysmal response during intermittent photic stimulation.The patient was diagnosed with vestibular epilepsy with postictal headache after exclusion of alternative causes of episodic vertigo.Treatment with extended-release divalproex sodium resulted in a marked reduction in attack frequency and improvement in symptoms during follow-up.Vestibular epilepsy represents an uncommon seizure manifestation in which vestibular symptoms predominate and may occur in isolation.In this patient, the brief stereotyped attacks, normal brain neuroimaging, absence of peripheral vestibular abnormalities, epileptiform electroencephalographic findings, and favorable response to antiseizure therapy supported the diagnosis.In cases of recurrent episodic vertigo presenting concurrently with headache, vestibular epilepsy remains a diagnostic challenge, mainly because overt neurological manifestations are often absent.Recent literature suggests that electroencephalography should be considered in patients with recurrent unexplained brief vertigo, particularly when episodes are stereotyped or resistant to conventional vestibular therapies.